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HomeMy WebLinkAboutCLE201700248 Application 2017-11-06Application for Zo rniinn Clearance *- # I(1�9'Q REVIEW ALL 3 SHEETS OFFICECLE USE1\ LY 1-7PLEASE Check # Date: Receipt # Staff: vw PARCEL INFORMATION Tax Map and Parcel: 0 q c— 61- 0 S— 0 A— Q 110 y Existing Zoning L 1 Parcel Owner: Qoy-Ayne(C\A1 9,eny01ls LL L Parcel Address: 223 1 SPiV11 null LY) City N IM6011C State V Zip W0+ (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? c c Address : S�� r-Q!Q 1 nJ Lcq,Q City L S State j� Zip;Pq3X, z� l Office Phone: ( Cell #/r'YD v� Fax # E-mail v q 8 Am Co vet- h�' (� �, n1 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: Reo\l esfAre Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide:.. 30 Assocge ti S IDW Q USvIAIIU \0 ASSOCI a3,-S IJ4pSC-4- 4 01n(, 1Ivn-4- Sumo did, 9100 1 *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accur th est of my knowled 1 have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed UJ 7 APPKOVAL INFORMATION [14 Approved as proposed [ ] Approved with conditions [ ] Denied [ ] B�,ckflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17. [ o physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official Date Zoning Official Date (0 % Other Official Date County of Albemarle Department of Community Development 401 117clntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 11/02/2015 Page 2 of 3 Intake to complete the following: Y /6N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y nN Wilteere be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on private well o ublic wate If private well, provide Healt artment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or blic sewer? Y Wi be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y Wi ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: 3,U© 0 Sq Ff eernutedas: aalmlrltA7'�P 1GFCSS�U��� I A Under Section: I •2- 1 (b) 1 Supplementary regulations section: Parking formula: 'IzO -') net Required spaces: I�, Y/N Ite be verified in the field: Inspector : Date: Notes: Vio s: Y I/ NI If s ist: Pro rs: Y//N If sBList: Vari�e: Z'�1V/ If s , 1St: SP's- YQ If ,st: Clearances: Y10;1� SDP's 24 ry ZI'l2_ Revised l 1/1/2015 Page 3 of 3 I— Cfa O O i17L4p C- P^� C Chi ��